고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례

@article{ART002174715},
author={ 강정호 and 박현수 },
title={고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례},
journal={대한임상독성학회지},
issn={1738-1320},
year={2016},
volume={14},
number={2},
pages={151-154},
doi={10.22537/jksct.2016.14.2.151},
url={http://dx.doi.org/10.22537/jksct.2016.14.2.151}

TY - JOUR
AU - 강정호
AU - 박현수
TI - 고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례
T2 - 대한임상독성학회지
PY - 2016
VL - 14
IS - 2
PB - 대한임상독성학회
SP - 151-154
SN - 1738-1320
AB - Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.
KW - Insulin lispro, Hypoglycemia, Overdose
DO - 10.22537/jksct.2016.14.2.151
UR - http://dx.doi.org/10.22537/jksct.2016.14.2.151
ER -

강정호 and 박현수 (2016). 고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례. 대한임상독성학회지, 14( 2), 151- 154.

강정호 and 박현수 . 2016, “고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례”, 대한임상독성학회지, vol. 14, no. 2, pp. 151-154. Available from: doi:10.22537/jksct.2016.14.2.151

강정호 박현수 et al. “고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례” 대한임상독성학회지 14.2 pp. 151-154 (2016): 151.

강정호 , 박현수 . 고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례 대한임상독성학회지 [Internet]. 2016; 14( 2), : 151-154. Available from: doi:10.22537/jksct.2016.14.2.151

강정호 and 박현수 . “고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례” 대한임상독성학회지 14, no.2 (2016): 151-154. doi: 10.22537/jksct.2016.14.2.151

홈 권호 목록 논문 목록 논문 상세

고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인지속적 저혈당성 혼수 환자 1례

대한임상독성학회지

약어 : J KOREAN SOC CLIN TOXICOL

2016, vol.14, no.2, pp.151 - 154

DOI : 10.22537/jksct.2016.14.2.151

발행기관 : 대한임상독성학회

연구분야 : 응급의학

강정호¹ , 박현수²

¹제주대학교병원 응급의학과

²제주대학교

인용한 논문 수 : - 서지 간략 보기

초록

Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.

키워드

Insulin lispro, Hypoglycemia, Overdose

참고문헌(7)

[학술지] Brvar M / 2005 / Prolonged hypoglycaemia after insulin lispro overdose / European Eur J Emerg Med 12 : 234 ~ 235
[학술지] Doğan FS / 2012 / Insulin glargine overdose / J Pharmacol Pharmacother 3 : 333
[학술지] Gundgurthi A / 2012 / Insulin poisoning with suicidal intent / Indian J Endocrinol Metab 16 (1) : S120 ~ S122
[학술지] Hawton K / 2000 / Doctors who kill themselves: a study of the methods used for suicide / QJM 93 : 351 ~ 357
[학술지] Lee P / 2009 / Plasma insulin concentration is useful to guide glucose supplement in insulin overdose / Intensive Care Med 35 : 181 ~ 182
[인터넷자료] Humalog / Summary of product characteristics
[학술지] Cryer PE / 2009 / Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline / J Clin Endocrinol Metab 94 : 709 ~ 728